Contraception NuvaRing

1. I understand the questions above and have answered honestly. I understand that any inaccurate or false information could potentially be dangerous to my health and safety.
2. The medication that is prescribed is for my personal use only. I understand the side effects and effectiveness of the treatments.
3. I agree to the Terms & Conditions of this platform.
4. I am 18 years or older.
5. I am currently living in South Africa.
6. I will have an in-person medical consultation at least once a year for comprehensive care and physical examination.
7. I acknowledge that a doctor will communicate with me via WhatsApp within 24 hours.

Please remember the following when using contraceptive medications:

• 💊Ring contraception is over 99% effective in preventing pregnancy when used as prescribed. It's crucial to follow the insertion and use instructions properly.

• 😷Common side effects include nausea, mood changes, weight fluctuation, and changes in menstruation. Most are mild and should subside over time. However, please urgently visit your nearest emergency department if you experience severe symptoms like intense headaches, chest pain, leg swelling or prolonged bleeding as they can indicate rare but serious conditions.

• 🍌It's important to note that while effective for pregnancy prevention, hormonal contraceptives do not protect against sexually transmitted infections (STIs). Please use barrier methods such as condoms for STI protection.

• 🚭Get regular breast examinations and regularly self-examine yourself and visit an in-person doctor if you feel any lumps. Look in the mirror for changes, then feel all areas in circles (lying down & standing up). Regularly monitor your blood pressure, have pap smears at the recommended intervals and avoid smoking.

• Always read the medication leaflet for full instructions and possible side effects.

⛔Please urgently visit your nearest emergency dept or in-person doctor if you are experiencing symptoms such as severe pain, chest pain, difficulty breathing, allergic reactions, dizziness, weakness, or other severe symptoms. Telemedicine services are not suitable for emergency medical conditions.

Consent

• Purpose of Treatment: NuvaRing (combined hormonal vaginal ring) for the purpose of preventing pregnancy.
• How to Use: Insert one vaginal ring into the vagina and leave in place for 3 weeks, then remove for 1 week to allow a withdrawal bleed. Insert a new ring after the ring-free week. If the ring is out for more than 3 hours, follow the instructions provided and use backup contraception if advised. NuvaRing does not protect against sexually transmitted infections (STIs). Condoms are recommended if STI protection is required.
• Expected Outcomes: Highly effective contraception when used correctly and consistently. Does not require daily dosing. Fertility usually returns quickly once NuvaRing is stopped
• Possible Side Effects:

• Common:
  • Nausea
  • Breast tenderness
  • Headache
  • Mood changes
  • Vaginal discharge or irritation
  • Irregular spotting or breakthrough bleeding (especially in the first few months)
• Less Common:

• • High blood pressure
  • Skin changes (acne, pigmentation)
  • Ring discomfort or awareness

• Rare but Important (Seek Medical Attention Immediately):
  • Blood clots (deep vein thrombosis, pulmonary embolism) - warning signs include calf pain/swelling, chest pain, sudden shortness of breath
  • Stroke or heart attack (rare, more likely if smoking, age over 35, or with certain health risks)
  • Liver problems (jaundice, severe abdominal pain)
  • Combined hormonal contraception may slightly increase the risk of breast cancer

• Alternative contraceptive options:

• Oral contraception
• Injectable contraception
• Implants, intrauterine devices (IUDs)
• Barrier methods (condoms, diaphragm)
• Permanent methods (tubal ligation, vasectomy)

If you require an invoice for medical aid, please fill out the below

Submitting this clinical form with any “⛔ (do not proceed)” conditions will disqualify you from receiving a prescription.

Please urgently visit your nearest emergency dept or in-person doctor if you are experiencing symptoms such as severe pain, chest pain, difficulty breathing, allergic reactions, dizziness, weakness, or other severe symptoms. Telemedicine services are not suitable for emergency medical conditions.